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However, previous clinical trials seldom consider the impact of syndrome patterns on the outcome evaluation of TCM formulae. Qiliqiangxin (QLQX) capsule is a TCM formula with cardiotonic effect to improve the cardiovascular function for heart failure with proven efficacy from well-designed clinical trials. Though, there is no clinical trial with a large sample size and long assessment period that considers the relationship between TCM syndrome differentiation and the treatment efficacy of QLQX. In the present study, we design a study protocol to evaluate the relationship between TCM syndrome differentiation and the severity of heart failure as well as its progression. Furthermore, we will evaluate the impact of the TCM syndrome patterns on the efficacy of QLQX in the outcome of heart failure.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This is a clinical study conducted in conjunction with an ongoing clinical trial (QUEST Study) by sharing the parent patient populations but with different aims and independent designed roadmaps to investigate the TCM syndrome pattern distributions and the impacts of syndrome pattern types on the efficacy of QLQX in HF treatment. The clinical trial involves over 100 hospitals in mainland China and Hong Kong SAR with 3080 HF patients. By assessing the morbidity and re-hospitalization, we will verify and apply a modified TCM Questionnaire to collect the clinical manifestations of HF and acquire the tongue images of the patients to facilitate the syndrome differentiation. We will base on the \u201c2014 Consensus from TCM experts on diagnosis and treatment of chronic heart failure\u201d to evaluate the TCM syndromes for the patients. A pilot study with at least 600 patients will be conducted to evaluate the reliability, feasibility and validity of the modified TCM questionnaire for syndrome differentiation of HF and the sample size is calculated based on the confidence level of 95%, population size of 3080 and 5% margin of error. Secondly, we will investigate the characteristic of TCM syndrome distribution of HF patients and its correlation with the functional and biochemical data. Furthermore, we will evaluate the relationship between the TCM syndrome patterns and the efficacy of QLQX in the treatment of heart failure. Lastly, we will investigate the implication of tongue diagnosis in the severity and therapeutic outcome of HF.<\/jats:p><\/jats:sec><jats:sec><jats:title>Expect outcomes<\/jats:title><jats:p>To our knowledge, this is the first large scale clinical trial to evaluate the impacts of TCM syndrome differentiation on the progression and therapeutic outcome of HF patients and explore the diagnostic value of TCM Tongue Diagnosis in HF patients. We expect to obtain direct clinical evidence to verify the importance of TCM syndrome differentiation for the diagnosis and treatment of HF.<\/jats:p><jats:p><jats:italic>Trial Registration:<\/jats:italic>The trial was registered at Chinese Clinical Trial Registry,<jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"http:\/\/www.chictr.org.cn\">http:\/\/www.chictr.org.cn<\/jats:ext-link>. (Registration No.: ChiCTR1900021929); Date: 2019-03-16.<\/jats:p><\/jats:sec>","DOI":"10.1186\/s13020-021-00515-1","type":"journal-article","created":{"date-parts":[[2021,10,16]],"date-time":"2021-10-16T17:20:09Z","timestamp":1634404809000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":21,"title":["Study protocol: Traditional Chinese Medicine (TCM) syndrome differentiation for heart failure patients and its implication for long-term therapeutic outcomes of the Qiliqiangxin capsules"],"prefix":"10.1186","volume":"16","clinical-trial-number":[{"clinical-trial-number":"chictr1900021929","registry":"10.18810\/chictr"}],"author":[{"given":"Alice Yeuk Lan","family":"Leung","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hoiyong","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhenhua","family":"Jia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xinli","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4772-5300","authenticated-orcid":false,"given":"Jiangang","family":"Shen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,10,16]]},"reference":[{"issue":"16","key":"515_CR1","doi-asserted-by":"publisher","first-page":"e147","DOI":"10.1016\/j.jacc.2013.05.019","volume":"62","author":"CW Yancy","year":"2013","unstructured":"Yancy CW, Jessup M, Bozkurt B, Butler J, Casey JDE, Drazner MH, et al. 2013 ACCF\/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation\/American Heart Association Task Force on Practice Guidelines. 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The study is conducted in accordance with the principles of Good Clinical Practice and the Declaration of Helsinki. This study is conducted in conjunction with a current trial which is registered at. All participants must give written informed consent which should be acquired after a sufficient and detailed explanation to the research situation (including confidentiality, risk and benefits, the purpose of the study, etc.). For Hong Kong, the clinical trial is approved by the Department of Health with Certificate For Clinical Trial and Medicinal Test (Certificate No. CTMT-00008).","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The design of the study, data collection, data analysis and interpretation are independent to the funding body. All executive committee members of QUEST study have received consulting fees as well as travel and research support in the planning and conduct of the QUEST study. The authors declare that they have no other conflict of interest to disclose.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"103"}}